Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment

Abstract

Stopping OAT 3 months after ICE-PVAI seems to be safe in patients without AF recurrences after the first 3 months following ablation. Further randomized-controlled studies are needed to confirm these preliminary data.

The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation

“…As far as we know, this is the largest set of case records compiled on patients who have undergone long-term suspension of OAT, in terms of both the total number of patients (n ϭ 2,692) and the number of moderate-/high-risk patients (723 patients with CHADS 2 score 1 and 347 patients with CHADS 2 score Ն2), in whom OAT is recommended or suggested by the international guidelines (1,2). Our results are substantially in line with those of other recently published retrospective studies involving smaller populations and shorter follow-up periods (13)(14)(15)(16). In particular, they are similar to those observed by Nademanee et al (14).…”

“…Patients with a thromboembolic risk of 2% per year or less do not benefit substantially from OAT, and according to the international guidelines should not be treated with this therapy (1). All of the studies, included ours, conducted to date on patients who have undergone successful AF ablation report a decidedly lower incidence of TE than that required by the guidelines (13)(14)(15)(16). Another reason for administering OAT after AF ablation is that extensive LA lesions might impair LA function, as observed by Lemola et al (24) on performing LA circumferential ablation in patients with paroxysmal AF.…”

Periprocedural management of anticoagulation and antiplatelet therapies in patients undergoing electrophysiologic procedures

“…Warfarin should be continued in patients with a CHADS 2 (congestive heart failure, hypertension, age, diabetes, prior stroke or transient ischemic attack) score ≥ 2. The safety of discontinuing anticoagulation 3 months after pulmonary vein isolation was evaluated in 85 consecutive patients [28]. Anticoagulation was not stopped in patients with AF recurrence, severe pulmonary vein stenosis, poor atrial contractility on TEE, or another indication for anticoagulation.…”

Anticoagulant cessation following atrial fibrillation ablation: limits of the ECG-guided approach

“…In addition, several studies supported feasibility and safety of discontinuing OAC after successful ablation reporting low thromboembolic and reduced bleeding risks [11][12][13][14][15].…”

“…Rossillo et al [11] suggested atrial contractility assessment at transesophageal echocardiography amongst the criteria for continuing/discontinuing OAC following 9 successful AF ablation. A transesophageal echocardiographic evaluation was performed in all patients at 3-month follow-up examination.…”